Paper presents the experience of treatment of 125 patients (120 males and 5 females) with the first episode of spontaneous pneumothorax over the period of time from 2010 to 2014. Treatment modalities applied included pleural puncture, pleural drainage with chemical pleurodesis, thoracotomy and removal of the affected portion of the lung, video-assisted and thoracoscopic lung resection with the induction of pleurodesis. Air leakage via the drain more than 48 hours long is an indication for surgery. Anti-relapse surgery is preferable with the use of thoracoscopic technique and pleurodesis is mandatory which may be accomplished by all means. At that pleurectomy should be preferred. Minimally invasive procedures allow shortening the length of hospital stay by 3—4 days. In case of technical difficulties or in the absence of possibility for thoracoscopy surgery may be made through thoracotomy approach.